Iranian Journal of Pathology

The Epidemiological, Clinical, Mycological, and Pathological Features of Rhino-cerebral Mucormycosis: A Systematic Review

Document Type : Systematic Review

Authors

Mohammadreza Salehi 1
Shahram Mahmoudi 2
Omid Rezahosseini 3
Sayed Jamal Hashemi 4
Kazem Ahmadikia 4
Farzad Aala 5
Nasim Khajavirad 6
Neda Alijani 7
Alireza Izadi 4
Muhammad Ibrahim Getso 8
Alireza Abdollahi 9
Arezoo Salami 1
Seyedeh Rana Khatami 1
Alireza Adibimehr 1
Mojtaba Hedayat Yaghoobi 10
Mohammadmahdi Sabahi 11
Behshad Pazooki 6
Farhad Yazdi 12
Jayran Zebardast 13
Arash Seifi 1
Malihe Hasan Nezhad 1
Masoud Mardani 14
Sadegh Khodavaisy 4

1 Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

3 Viro-immunology Research Unit, Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

4 Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

5 Department of Parasitology and Mycology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran

6 Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

7 Department of Infectious Diseases, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

8 Department of Medical Microbiology and Parasitology, College of Health Sciences, Bayero University, Kano, Nigeria

9 Department of Pathology, School of Medicine, Imam Khomeini Hospital Tehran University of Medical Sciences, Tehran, Iran

10 Department of Infectious Diseases, Alborz University of Medical Sciences, Karaj, Iran

11 Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran

12 Department of Infectious Diseases, Arak Social Security Organization Hospital, Arak, Iran

13 Neurocognitive Science special Linguistics, Institute for Cognitive Science Studies, Tehran, Iran

14 Infectious Disease and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

https://doi.org/10.30699/ijp.2022.538690.2721
Abstract
Cerebral mucormycosis (CM) is a life-threatening manifestation of mucormycosis, an angioinvasive fungal infection caused by Mucorales. We sought to systematically review all available case reports to describe epidemiologic features, clinical manifestations, predisposing factors, and diagnostic and treatment strategies of CM. A systematic search was conducted using a combination of the following keywords: "Mucor", "Zygomycetes", "mucormycosis", "cereb*", "brain", "central nervous system", and "intracranial", separately and in combination until  December 31st 2018. Data sources included  PubMed, Scopus, EMBASE, Web of Science, Science Direct, and Proquest without limiting the time of publication. We included 287 articles corresponding to 345 cases of CM. Out of the 345 cases, 206 (60%) were male with a median age of 44 years; 130 (38%) were reported from North America; 87 (25%) from Asia; and 84 (24%) from Europe. The median time from onset of symptoms to presentation was 3-7 days (65/345, 65%). The highest mortality was observed among patients with diabetes mellitus (P=0.003). Debridement of infected brain tissue was associated with improved survival in CM cases (OR 1.5; 95% CI 01.3-1.8; P<0.0001). The use of liposomal amphotericin B (L-AMB) was significantly associated with patients' recovery (OR 2.09; 95% CI 1.2-3.4; P=0.003). The combination of L-AMB and posaconazole (12.5%) was more effective than the monotherapy treatment of CM cases (P=0.009). Clinicians should consider DM as an important risk factor for CM. Moreover, surgical debridement and antifungal combination therapy could be an effective approach in the management of CM patients.

Highlights

  • A set of 287 articles containing 345 cases of cerebral mucormycosis were included.
  • Diabetes mellitus without ketoacidosis (n=176, 51%) followed by hematological malignancy or hematopoietic stem cell transplantation (n=80, 23.2%) were the most common underlying conditions.
  • Orbital symptoms (n=160, 46.3%) and neurological symptoms (n=142, 41%) were the most common symptoms.
  • Multiple cerebral lobes (n=100, 28.9%) and temporal lobe (n=54, 15.6%) were the most common pattern of involvement.
  • Regarding the outcome, 136 (39.4%) of 345 patients died.

Keywords

Cerebral mucormycosis
Diabetes mellitus
Invasive fungal infections

Subjects

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Iranian Journal of Pathology
Volume 17, Issue 2
Spring 2022
Pages 112-121

  • Receive Date 13 September 2021
  • Revise Date 28 September 2021
  • Accept Date 05 October 2021

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